1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Big Spring
Inc Town: near Big Spring
City:
No.
St.
Ward
Registration District No.: 5314
Primary Registration District No: 14
File No. 21641
Registered No: 8
1. FULL NAME: Clara Allen Lawson
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: December 23, 1872
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 39yrs9mos7ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: housewife
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Joe Claycomb
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Nancy Meador
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) W.G. Lawson
(Address) Irvington, Ky RFD #1
14. Filed Oct 4, 1912
REGISTAR: J.L. Morris
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: September 30, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): July 12, 1911 to Sept 30, 1912
That I last saw him/her alive on (date): Sept 30, 1912
And that death occurred on the date stated above at (time AM/PM): 8PM
THE CAUSE OF DEATH was as follows:
Phthisis
(Duration)
Years: 1
Months: 2
Days: 18
Contributory: Pleurisy
Signed (M.D.): R.W. Meador
Date: Oct 1, 1912
Address: Custer, Ky
17. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):
In the State (yr, mo, da):
Where was disease contracted,  if not at place of death?
Former or usual residence:
18. PLACE OF BURIAL OR REMOVAL: Cedar Hill Cemetery
DATE OF BURIAL: Oct 2, 1912
19. UNDERTAKER: GT Marshall & son
ADDRESS: Irvington, Ky